Provider Demographics
NPI:1467658435
Name:BROOKS, REQUISHA DENEE (CNA)
Entity Type:Individual
Prefix:
First Name:REQUISHA
Middle Name:DENEE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 .EAST MARTIN LUTHER KING APT 1
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:AR
Mailing Address - Zip Code:72360
Mailing Address - Country:US
Mailing Address - Phone:870-821-1415
Mailing Address - Fax:
Practice Address - Street 1:218 E. MLK APT 1
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:AR
Practice Address - Zip Code:72360
Practice Address - Country:US
Practice Address - Phone:870-821-1415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR374U00000X374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide